Help Available For Doctors in Crisis



By Barbara Kermode-Scott

Medical Post

October 12, 2004


CALGARY - It can certainly be tough being a doctor. Some physi­cians become so busy caring for others they no longer care for themselves. With physician shortages across Canada, both anecdotal evidence and research sug­gest that physicians are sacrificing their personal health to meet the ever-increasing demands of Canada's health-care system. The stats are scary: Physicians have twice the suicide rate of the general Canadian population.


Last year the Canadian Med­ical Association (CMA) raised concerns about the issue of physi­cian health and launched a centre for physician health and well-being. A CMA survey had revealed that, out of 2,251 physicians surveyed, almost one in two (45.7%) were in an advanced phase of burnout. These doctors were showing clear signs of depersonalization in their relationships and were feeling that they were ineffective, emotionally overrun and ex­hausted.


Canada's medical organizations are working hard to address this issue. The CMA's Centre on Physi­cian Health and Well-being is developing a national professional development curriculum to be piloted this fall for a course on physician health. This will be aimed at physician leaders with an interest or mandate to promote the wellness of their physi­cian colleagues, explains Dr. Mamta Gautam, chairwoman of the CMA's physician health expert advisory group.


"This course should be a huge asset to train key medical deci­sion-makers on this issue," said Dr. Gautam, who also writes "Helping Hand," a monthly col­umn for the Medical Post. At its annual meeting this summer, the CMA passed a reso­lution to explore the feasibility of promoting an annual National Physicians' Week to celebrate the contributions of Canadian physi­cians. "I am personally excited by this," said Dr. Gautam. "I firmly believe that appreciation of one's work leads to a healthier work environment, and improved morale and job satisfaction.”


Alberta programs


At the provincial level much is being done, too. In Alberta, for instance, there’s a long history of providing physician support programs. The Alberta Medical Association physician and family support program provides confidential help for Alberta physicians, residents, medical students and their families.


Alberta has been a pioneer with its physician and family support program, suggested AMA president Dr. Brendan Bunting.


“It’s no longer appropriate to just take a passive role,” he stressed. “A lot of Canada’s physician support programs are providing early intervention rather than after-the-fact intervention... Doctors feel they should help their colleagues... I think it's a good thing that families are sup­ported as well as physicians."


Over the years, the program's founder and, until Sept. 1, when she stepped down, director Robin Robertson has observed changes in how physicians are being af­fected by stress in the workplace. These days, resource constraints are certainly an issue, she explained. With fewer doctors dealing with more demands, physicians are placed under higher stress than ever.


Generational change


“At the same time, we have a generation of physicians coming up who are saying, 'I'm not prepared to give my life to this' the way the generation before me did. I believe that I can have both-I can have a life and a profession."


Robertson feels the next gener­ation of physicians is going to be more willing to do what's neces­sary to have a balanced lifestyle, whereas those who preceded them were more willing to sacrifice their personal time for medicine. "There was a different kind of work ethic... One's not bet­ter than the other. They're just very different."


The very thing that makes medi­cine an exciting career also makes it a career with a potential for burnout, she pointed out. The Alberta program tries to introduce physicians to ideas that will help them be more resilient in times of stress.


"It's really about helping peo­ple make changes, positive changes in their lifestyle prior to the 'cosmic two-by-fours,' " explained Robertson. "The 'cosmic two-by-fours' are things like marriage break up, heart attacks and other serious things that happen in our lives...My favourite saying is: 'Life is a journey, not a guided tour.' We don't plan for the bad stuff that happens in our lives."


Although some people are quite reluctant to make a cause-and-effect connection between overwork and an unhappy lifestyle, a heart attack or a marriage breakdown, intuitively we all know there is a connection,

she suggested.


"We do have studies that link those two things together in the workplace--workplaces where there is high demand and little control. We end up with employees who end up getting sick…Physicians have high demand and little control. They really do fit into this category."


It can be tough for the younger audiences, the residents and medical students, to understand they need to prepare for when things go badly in life, she added. They need life practices in place that will enable them to be resilient when they need to cope-not only with a demanding job but also with all the other stresses that can come along in life.


Talking about burnout


Another thing that's changed over the years is that there's a growing recognition that it's acceptable to talk about burnout, suggested Robertson. "People are saying it's not a sign of weakness that I'm feeling stressed or that I need somebody else's opinion about how to handle these things."


Another change has been the loss of collegiality at the local level, with the loss of doctors' lounges (now returning) and other opportunities for informal networking. "We're trying to help physicians see the need for collegiality," she explained. "We absolutely know that people who have good support systems live longer and are more resilient to stress."


Dr. Gautam also believes that how doctors handle stress now has changed in some ways, but adds that in some ways nothing has changed.


"Overall, the culture of medicine is slowly changing and allowing that we are vulnerable to stress, and that it is OK to take care of our­ selves," she explained. "We see young physi­cians lead healthier, balanced lives, set better limits and more realistic work goals; and work to prevent stress and burnout. It is more acceptable to acknowledge that we may need help. There are more re­sources available and more resources are being utilized by col­leagues. Yet, we have a long way to go. The culture still has high expectations of us, and our per­sonalities are unchanged. As a re­sult, we remain highly conscientious and responsible, delay our own gratification and continue to make ourselves vulnerable to stress."


As for the "cosmic two-by­ fours," she said doctors are people, too, and major negative events will impact them just as they would others.


"However, it is how we express this impact that may be different. I am not sure if we handle it bet­ter or worse. In part, it can be bet­ter, since we are used to dealing with difficult news, and can use these skills here. We know there is help available and where to go for it. However, we can also go into an intellectualizing mode, as at work, which is not helpful in the long run as it enables us to avoid dealing with and reacting to the problem. Although we know there is help available, we do not always, or readily, access it."